HomeMy WebLinkAboutPermit Electrical 2007-2-15
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726.3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number C1rrvl :J I){) (0 - () /.<,n;;1,
Date
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1. LOCATION OF INSTALLATION:
J::;CJj -PU~ jp ~
3. COllfPLETE FEE SCHEDULE BELOW
LEGAL DESCRIPTION:
\70') ZZ.cCz.
JOB DESCRIPTION:
~c.A. t/.J PAIAU'I I go C 10/' C4A ~h;
Permits are non-transferaJe and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
ObZLI
A, New Residential- Single or Multi-Family per dwelling nnit.
Service Inclnded
1000 sq. ft, or less
Each addilionaJ 500 sq, ft, or
ponion thereof
Each Manufacl'd Home or
Modular Dwelling Service or
Feeder
$106,00
W $ 19.00
$50,00
. .
CONTRACTOR INSTALLATION ONLY \1~.yoSe\Q'ices or Feeders -Installation, Alterations or Relocation:
2. n ",.~. C.' .;oW f\l~~e~O"lJ~\\\W , .
Electrical Conlrac(or \ f&1;,t!Ji-lK-'fi!1.,"lt~cfi? QVo'~Q,~Ii\~ or less , $ 63.00 t03,{jl)
1~l'ri'~\\\~1! ..14~ f:~pGPTl!\O&.~2J.!J'a;I:~2 to 400 Amps $ 75,00
Address J?I.3G ~~~'.3.~9~~O\"lQ\lQi'I QH"tOJi\\~&~IO 600 Amps $125,00
/1/J A .O()\l~ ;~r\-l\-l1.l~~~i" ~~~\~~\Q\~1~~l\\{0 1000 Amps $163.00
City Q'i!f--/e',.(.. \}, \\)Piidrt\1~~;:~dS'~~{\'l\)j ~~\9!\}'li'~oo AmpslVolts $375.00
~ \U-;"'\\\\\C?"~€~6'e GI~~~~'>,?r."MI\~connect Only $ 50.00
C 1'11>\.\9.' . .~I)I' '1, " "2'!F
~\\(1?Io"'" ~~m'''' ,......~- .
Supervisor License Number ~ ~S(.,:;S C. Temporary Sen'lces or Feeders
Constr, Contr, Number
Installation, Alteration or Relocatio~
200 Amps or less ~ $ 50.00
20 I Amps to 400 Amps $ 69,00
40 I Amps to 600 Amps $100.00
Expiration Date . S ~O 8'" Over 600 AmI'S(f.t;\\"llO,d-~ see. "B" above.
SSL:' nature of Supervising Electrician D. Br . ~V~,~~ ~'l;\
rn IJ , eWe\:\ili~'t\lIjt'$t~~~~fer Panel
L ~. _ ~ ~~e C~I.\ \~:>O10 l'\~ ~_!3.,00
- 'OC\~~'1 '-' oll;\ll~A'\l\lij:I.fti1~trcu.i~Ii)-Uilfl r/ "711
\ \.\~o:\l:~ or Feeder PermIt I\' $ 3.00 C-- ,
Owners Name Lp nb,,,..\.... >>,~" r., '_Q~ c;\ ~\. ~\ , ~
Address SS \ "1'\ -/\1) dr-lo ~\leY1~~ '1 E, . Miscellaneous (Service/feeder not included)_:::~ch IlIslallation
City S'(<"\J~ e\d Phone [S\-\\)n \-140l-/ Pump or irrigation ~.5.Q.OO
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Eleclric Permit Inspection Fee is $45.00 + Surcharges
4, SUBTOTAL OF ABOVE 87 r
8% Stale Surcharge b'b
10% Administrative Fee cf .W' 0
5% Technology Fee /D"7 ...-- l{ J- r
J'/O /8- 3
Expiration Date
/0-/-..')/
OWNER INST ALLA nON
Tbe installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building Fonns/ElccUical Pcnnit Application 8..Q6.dnc